Article

Continuous tracheostomy mechanical ventilation users with Duchenne
muscular dystrophy are institutionalized or have home nursing services (licensed
practical nurse/registered nurse), whereas patients dependent on continuous
noninvasive ventilatory support (CNVS) can avoid hospitalizations and publically
paid services. OBJECTIVE: This is a retrospective analysis comparing
cost and physician effort for managing CNVS and continuous tracheostomy
mechanical ventilation users with Duchenne muscular dystrophy. RESULTS: Compared
with ongoing personal care, physician services and intercurrent hospitalization
costs were negligible. Ten home continuous tracheostomy mechanical ventilation
users had 16.4 hrs per day of licensed practical nurse/registered nurse care
costing $269,370 per year; 14 were institutionalized at $237,350 per year; and 8
were decannulated to CNVS, with 5 subsequently returning home, costing only
$9,800 per year for respiratory equipment. For 93 CNVS users, costs ranged from
$9,800 per year for 37 without publically funded assistance, $44,968 per year for
3 with nurses' aides, $81,395 per year for 35 with unskilled personal assistance
services, and $239,805 per year for 12 with licensed practical nurses/registered
nurses. Twenty-eight became CNVS dependent without hospitalization or evaluation
for home care. CONCLUSIONS: Noninvasive management permits cost-effective living
at home but is disincentivized by fixed hospital diagnosis-related groups
compensation that encourages rapid tracheotomy as well as expensive
institutionalization and nursing care.

Langue : ANGLAIS